Active NPI
Chesterfield Clinic Corp
- Family Medicine Physician
- Cheraw, SC
National Provider Identifier
1154489706
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- Legal business name
- CHESTERFIELD CLINIC CORP
- Practice address
- 34 Foundry Hill Rd
Cheraw, SC 29520-2500 - Phone
- (843) 537-7074
- Fax
- (843) 537-2744
- NPI assigned
- Dec 5, 2006
- Organization subpart
- Yes
- Parent organization
- CHESTERFIELD CLINIC CORP
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Debbie T Brewer
- Title
- Director of Provider Enrollment
- Phone
- (615) 465-7626
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | SC | Primary |
Addresses
Primary practice location
34 Foundry Hill Rd
Cheraw, SC 29520-2500
Mailing address
34 Foundry Hill Rd
Cheraw, SC 29520-2500
Phone (843) 537-7074
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| GP2502 | Medicaid | SC | |
| GP3624 | Medicaid | SC |
Other names 1
- Primary Care of Cheraw
National Provider Directory
National Provider Directory- Tax ID family
- CHS Chesterfield Emp
- Part of
- CHS Chesterfield Emp
Other organizations with this tax ID 3
Organizations that report the same tax identification number in the National Provider Directory.
-
- Family Medicine Physician
- Cheraw, SC
- NPI 1013986405
-
- Orthopaedic Surgery Physician
- Cheraw, SC
- NPI 1093883001
-
- Pediatrics Physician
- Cheraw, SC
- NPI 1346262961
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1165276800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1190246400000",
"number": "1154489706",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "34 FOUNDRY HILL RD",
"city": "CHERAW",
"state": "SC",
"postal_code": "295202500",
"telephone_number": "843-537-7074",
"fax_number": "843-537-2744"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "34 FOUNDRY HILL RD",
"city": "CHERAW",
"state": "SC",
"postal_code": "295202500",
"telephone_number": "843-537-7074",
"fax_number": "843-537-2744"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "CHESTERFIELD CLINIC CORP",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "CHESTERFIELD CLINIC CORP",
"enumeration_date": "2006-12-05",
"last_updated": "2007-09-20",
"status": "A",
"authorized_official_last_name": "BREWER",
"authorized_official_first_name": "DEBBIE",
"authorized_official_middle_name": "T",
"authorized_official_title_or_position": "DIRECTOR OF PROVIDER ENROLLMENT",
"authorized_official_telephone_number": "615-465-7626"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Family Medicine",
"state": "SC",
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "GP2502",
"state": "SC"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "GP3624",
"state": "SC"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "Primary Care of Cheraw",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Cheraw, SC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 20, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.